Please choose a method below to submit your request.  We HIGHLY RECOMMEND using the direct message method so we can respond to your request quickly AND accurately.

Submit a Request

Inquiry

Contact Details

Practice or Law Firm associated with the patient
Number where you can be reached
Contact Name
If a follow up reply is necessary we will use this email address

Inquiry Type

Please note we require a signed lien by the attorney before we can send any bills

Please enter your information below and we will mail your referral forms within 2 business days.

Fax number where we should send your request
Email address where we should send your request

Specific Details (if needed)

Where should we mail your request?
Address
Suite or Unit Number
City
State/Province
Zip/Postal
Please be as specific as possible so we can assist you in a timely manner
Drop a file here or click to upload Choose File
Maximum upload size: 10MB
File Type: PDF, Word, Excel, JPG Zip or RAR . Max of 5 files can be uploaded at 10MB each

Please make sure to email the correct department below to prevent delays in processing your request.

Make sure to include specific details about your request  including practice or office name,  contact name, phone and email.  For the patient make sure to include their First and last name, DOB.

Make sure to include specific details about your request  including practice or office name,  contact name, phone and email.  For the patient make sure to include their First and last name, DOB.

Please make sure to send a fax to the correct department below.

Billing           888-777-4356
Reports         888-398-2921
Subpoenas   888-343-2740
General         888-715-7001